EL VALOR DE LA CREATIVIDAD
4.2. INSTITUCION PARTICIPANTES
FIG. 2. Outline of the facilities and activities, and the personnel considered during:
(a) assessment of the education and training needs (Section I.2); (b) design of a national education and training programme (Section I.3); and (c) development and implementation of the national education and training programme (Section I.4). QE: qualified expert;
RPO: radiation protection officer; Op: operator; HP: health professional (includes all professionals in the medical field except those already considered in the previous categories).
In the case of a country establishing a national education and training programme, all the facilities and activities present in the country and regulated by national legislation and regulations, as well as all the categories of personnel for whom education and training requirements in radiation safety are established, need to be considered. QEs and RPOs will always be taken into consideration, owing to their central role and responsibilities in radiation safety. The entire four phase process (including the evaluation of the national education and training programme as presented in Section 6) needs to be applied.
I.2. ASSESSMENT OF EDUCATION AND TRAINING NEEDS
I.2.1. Legal and regulatory framework for education and training (Section 3.1)
At this stage, the government of the hypothetical country has established a regulatory body (Requirement 3 in Ref. [1]) and appropriate requirements for education, training, qualification and competence have been established for persons engaged in radiation protection and safety activities (para. 2.21 in Ref. [2]).
The regulatory body ensures the application of the requirements for education, training, qualification and competence in radiation protection and safety (para. 2.32 in Ref. [2]).
The registrants, licensees and employers ensure that all personnel engaged in activities relevant to protection and safety have appropriate education, training and qualification so that they understand their responsibilities and can perform their duties competently, with appropriate judgement and in accordance with the procedures (paras 2.41, 2.42 and 2.44 in Ref. [2]).
In particular:
— Requirements are established for the formal recognition of the QE (para. 2.21(b) in Ref. [2]). In the hypothetical country, the QE is recognized in the general field of radiation protection, but further requirements have been established with regard to the specific practices the QE could be asked to provide advice on. The number of QEs needed per practice is not specified. All facilities will need the advice of, and access to, a QE. In some complex facilities, the QE may be an employee of the facility, in other cases a consultant.
— Employers, registrants and licensees, in consultation with workers or
regulatory body specifies that RPOs are needed for all practices. However, one RPO may serve several departments (e.g. with regard to the diagnostic and interventional radiology practice in a hospital, an RPO may be designated for different radiology departments).
— Employers, registrants and licensees ensure that, for all workers engaged in activities in which they are or could be subject to occupational exposure, suitable training in protection and safety is provided, as well as periodic retraining (Requirement 21 and para. 3.76(h) in Ref. [2]). Registrants and licensees provide appropriate information, instruction and training for persons working in controlled areas (Requirement 24 and para. 3.90(i) in Ref. [2]). Employers, in cooperation with registrants and licensees: provide all workers with adequate instruction, training and periodic retraining in radiation protection and safety, and sufficient information on the significance of their actions; provide those workers who could be involved in or are affected by the response to an emergency with appropriate information, adequate instruction, training and periodic retraining, for protection and safety (Requirement 26 and paras 3.110(a) and (b) in Ref. [2]). Employers, in cooperation with registrants and licensees, maintain records of the training provided to individual workers (Requirement 26 and para. 3.110(c), Requirement 42 and para. 3.183(b) in Ref. [2]).
— The regulatory body identifies a category of personnel among the workers responsible for the day-to-day use of radiation sources (operators), trained in the operation of the equipment, and with a high level of expertise in their area of work [3]. Such workers are appointed by the employers and, in the hypothetical country, are authorized by the regulatory body. Examples of these workers are the personnel responsible for non-destructive testing (e.g. radiographers [10–12]), personnel in the industries handling naturally occurring radioactive material (NORM) [13], staff in the medical sector (e.g. diagnostic radiographers), research reactor operators [14], those involved in the transport of radioactive material [15] and workers in radioactive waste facilities [16]. The number of these workers depends on the needs of the facilities.
— The regulatory body requires that health professionals with responsibilities for medical exposure be specialized in the appropriate area (e.g. diagnostic radiology, image guided interventional procedures, radiotherapy and nuclear medicine), and they meet the requirements for education, training and competence in the relevant specializations (para. 3.150 in Ref. [2]).
They need to receive adequate education and training in radiation protection and safety as part of the process of building their specific competence.
— A process has been established to develop and maintain the necessary competence and skills of staff of the regulatory body [17], as an element
of knowledge management. This process includes the development of a specific training programme based on an analysis of the necessary competence and skills. The training programme covers principles, concepts and technological aspects, as well as the procedures followed by the regulatory body for assessing applications for authorization, for inspecting facilities and activities, and for enforcing regulatory requirements (para. 4.13 of Ref. [1]).
— Some guidance is available specifying the minimum levels of education and training (including on the job training) that have to be demonstrated by specific categories of personnel, such as RPOs, QEs, operators, health professionals and the staff of the regulatory body. The government has established which persons need to have particular qualifications and the process to be employed for the recognition of such qualifications (for example for QEs).
— In the hypothetical country, there is a training centre5 and relevant courses are recognized by the regulatory body [3].
I.2.2. Details on facilities and activities, and personnel to be educated and trained (Sections 3.2 and 3.3)
Tables 1 and 2 show the data collected for the facilities and activities, and categories of personnel to assess the training needs in the hypothetical country.
For simplicity, it is assumed that personnel with appropriate and adequate education levels are already available in the hypothetical country (for more details see the introduction to this appendix).
5 In the example, a national training centre (NTC) is in place. However, it may not be necessary to establish a dedicated radiation protection training centre. The relevant capabilities
TABLE 1. ASSESSMENT OF TRAINING NEEDS Type Facilities and activitiesQualified experts (QEs)Radiation protection officers (RPOs)OperatorsHealth professionals (HPs)a
Existing Foreseen (<5 years) Total Existing Estimated QEs required QEs to be trained Existing Estimated RPOs required RPOs to be trained
b
Existing Estimated operators required Operators to be trained Existing Estimated HPs required HPs to be trained
INDUSTRIAL AND RESEARCH Industrial radiography1121320c 0313108810416n.a.d n.a.d n.a.d
Industrial irradiator facilities (industrial and research) 202200220341n.a.d n.a.d n.a.d
Industrial gauges and well logging 3874523c 13845715218028n.a.d n.a.d n.a.d
Research activities: use of sealed and unsealed sources 1231507c 712153759015n.a.d n.a.d n.a.d
Research accelerators or reactors 20202222010133n.a.d n.a.d n.a.d
1. ASSESSMENT OF TRAINING NEEDS (cont.) Facilities and activitiesQualified experts (QEs)Radiation protection officers (RPOs)OperatorsHealth professionals (HPs)a
Existing Foreseen (<5 years) Total Existing Estimated QEs required QEs to be trained Existing Estimated RPOs required RPOs to be trained
b
Existing Estimated operators required Operators to be trained Existing Estimated HPs required HPs to be trained
1021206c 61012225030050n.a.d n.a.d n.a.d 500200700e000000300400100700900200 620120740e037c37225270456007401408001100300 3141433412028810144 13316016161316360701026326
TABLE 1. ASSESSMENT OF TRAINING NEEDS (cont.) Type Facilities and activitiesQualified experts (QEs)Radiation protection officers (RPOs)OperatorsHealth professionals (HPs)a
Existing Foreseen (<5 years) Total Existing Estimated QEs required QEs to be trained Existing Estimated RPOs required RPOs to be trained
b
Existing Estimated operators required Operators to be trained Existing Estimated HPs required HPs to be trained
OTHER PRACTICES Waste management facility101110110143n.a.dn.a.dn.a.d Veterinary radiology314000132363n.a.d n.a.d n.a.d
Security equipment (e.g. baggage X rays, container inspection, etc.) 527000572659530n.a.dn.a.dn.a.d
Isotope production operations and source manufacturing
101011110572n.a.dn.a.dn.a.d Uranium mines000000000000n.a.dn.a.dn.a.d a This category of personnel includes all professionals in the medical field except those already considered in the previous categories. b The number of RPOs to be trained reflects the fact that some of the existing facilities do not yet have RPOs as required by the regulations. c Not all practices need full time QEs. d n.a.: not applicable. e Number of devices.
I.3. DESIGN OF A NATIONAL EDUCATION AND TRAINING PROGRAMME
I.3.1. National resources and capabilities for training of the relevant personnel (Sections 4.1 and 4.2)
Based on the information about the personnel to be trained (Tables 1 and 2), competent authorities and education and training institutions have provided information about relevant existing training programmes at the national level.
Table 3 shows the data collected in the hypothetical country about training programmes in radiation protection and safety in the medical field. The professional association of dentists regularly organizes basic courses in the field of radiation protection; the courses comply with the requirements provided by the regulatory body for the minimum training levels for operators in the field. There is a national training centre (NTC) that has developed a comprehensive training portfolio in the field of diagnostic and interventional radiology for QEs (in collaboration with the Faculty of Physics at the national university and hospitals), RPOs and operators. In the fields of radiotherapy and nuclear medicine, courses are available only for operators.
TABLE 2. ASSESSMENT OF TRAINING NEEDS, REGULATORY STAFF
Existing Estimated regulatory staff required
Regulatory staff to be trained
Authorization 7 7 0
Inspection 5 15 10
Assessment 3 6 3
Enforcement 3 6 3
TABLE 3. NATIONAL RESOURCES IN THE HYPOTHETICAL COUNTRY FOR TRAINING IN RADIATION PROTECTION AND SAFETY IN THE MEDICAL FIELD
Facilities and
activities Personnel Training programme
Remarks
Provider Title Purpose
Dental
radiology Operator Professional
association Radiation protection in the use of X ray generators in dental radiology
Training of operators in radiation protection in dental radiology
n.a.a
Diagnostic and interventional radiology
QEs NTC with:
national university Faculty of Physics, hospitals
Advanced course in radiation protection in diagnostic and interventional radiology
Building QEs’
competence in radiation protection in diagnostic and interventional radiology
Course established by the NTC using, inter alia, the material developed by the IAEA,b,c complementary courses and on the job training (in collaboration with the university and hospitals) to comply with national requirements for the recognition of QEs
RPO NTC Training
course in radiation protection in diagnostic and interventional radiology
Training of RPOs in radiation protection in diagnostic and interventional radiology
Course established by the NTC using, inter alia, material developed by the IAEAd
TABLE 3. NATIONAL RESOURCES IN THE HYPOTHETICAL COUNTRY FOR TRAINING IN RADIATION PROTECTION AND SAFETY IN THE MEDICAL FIELD (cont.)
Facilities and
activities Personnel Training programme
Remarks
Provider Title Purpose
Operator NTC Radiation protection in the use of ionizing radiation in diagnostic and interventional radiology
Training of operators in radiation protection in diagnostic and interventional radiology
n.a.a
Radiotherapy Operator NTC Radiation protection in the use of ionizing radiation in radiotherapy
Training of operators in radiation protection in radiotherapy
n.a.a
Nuclear
medicine Operator NTC Radiation protection in the use of unsealed radiation sources in nuclear medicine
Training of operators in radiation protection in nuclear medicine
n.a.a
a n.a.: not applicable.
b IAEA training material on radiation protection in radiotherapy [18].
c Postgraduate Educational Course in Radiation Protection and the Safety of Radiation Sources: Standard Syllabus [6] (a revised version of this publication is in preparation).
d A syllabus for the training of RPOs at industrial and medical radiation facilities is in preparation.
I.3.2. Matching the needs to available resources and capabilities (Section 4.3)
domestic and foreign capabilities. Existing capabilities to match some of the training needs were identified in Table 3 for the medical field.
Table 4 shows an example of the training courses and other activities in the medical field that are required to address the needs in the hypothetical country as identified in Tables 1 and 2. The national education and training programme needs to address the training needs for QEs and RPOs in radiotherapy and nuclear medicine. For these practices, only the training of operators is available at the NTC (Table 3). The country might adopt the following approach:
(a) For radiotherapy, the number of personnel to be trained in the next five years might not justify the development of a national course. Therefore, personnel to be recognized or designated as QEs or RPOs will be trained making use of external resources, such as the IAEA Regional Training Centres (RTCs), located in specific IAEA Member States [19]. However, the country needs to carefully consider that the time needed to train personnel depends on the number of training vacancies in the RTC courses available to international participants:
(i) With regard to the training of QEs, since the country has a formal system of recognition for QEs based on general competence in radiation protection and safety complemented by additional knowledge on a specific practice, the regulatory body will endorse the postgraduate educational course in radiation protection and the safety of radiation sources [6], integrated with the practice specific course delivered by the RTC. Seminars and on the job training will also be required by the regulatory body to comply with national requirements for the recognition of QEs. These training activities will be organized by the Faculty of Physics in collaboration with hospitals (as in the case of QEs in diagnostic and interventional radiology).
(ii) For the training of RPOs, the regulatory body will endorse the training course delivered by the IAEA RTC and based on IAEA training material.
(b) For nuclear medicine, the number of personnel to be trained might justify the development of some national capabilities, making use of the available resources when possible and appropriate. In fact, the country is considering whether the development of some expertise at a national level in nuclear medicine could be important even for other practices and technological applications using unsealed sources.
(i) In order to address the need for QEs in a sustainable way, there will be a need to build the competence of the future trainers in the course to be established (Phase 1 in Table 4). The trainers will be trained on the technical aspects through a course in radiation protection provided by
4. MATCHING THE TRAINING NEEDS WITH NATIONAL AND INTERNATIONAL RESOURCES AND ABILITIES IN THE MEDICAL FIELD PersonnelProviderCourseAttendeesRemarks Operator Professional association Radiation protection in the use of X ray generators in dental radiology
100n.a.a QE
NTC with: national university Faculty of Physics, hospitals Advanced course in radiation protection in diagnostic and interventional radiology
37n.a.a RPONTC
Training course in radiation protection in diagnostic and interventional radiology
45n.a.a OperatorNTC
Radiation protection in the use of ionizing radiation in diagnostic and interventional radiology
140n.a.a
TABLE 4. MATCHING THE TRAINING NEEDS WITH NATIONAL AND INTERNATIONAL RESOURCES AND CAPABILITIES IN THE MEDICAL FIELD (cont.)
Facilities and activities
PersonnelProviderCourseAttendeesRemarks RadiotherapyQE
RTC
Postgraduate educational course in radiation protection and the safety of radiation sources
b
Specialized training course in radiation protection in radiotherapy
c
3
The number of personnel to be trained does not justify the development of a national course The regulatory body endorses the course
b provided at the RTC as
part of the framework for the recognition of QEs, but further practice specific courses (including the specialized training course
c delivered at the RTC),
seminars and on the job training are added to comply with national requirements for recognition of QEs
National university Faculty of Physics, hospitals Practice specific seminars and on the job training
4. MATCHING THE TRAINING NEEDS WITH NATIONAL AND INTERNATIONAL RESOURCES AND ABILITIES IN THE MEDICAL FIELD (cont.) PersonnelProviderCourseAttendeesRemarks QE
RTC
Postgraduate educational course in radiation protection and the safety of radiation sources
b
Specialized training course in radiation protection in radiotherapy
c
3
The number of personnel to be trained does not justify the development of a national course The regulatory body endorses the course
b provided at the RTC as
part of the framework for the recognition of QEs, but further practice specific courses (including the specialized training course
c delivered at the RTC),
seminars and on the job training are added to comply with national requirements for recognition of QEs
National university Faculty of Physics, hospitals Practice specific seminars and on the job training
4. MATCHING THE TRAINING NEEDS WITH NATIONAL AND INTERNATIONAL RESOURCES AND ABILITIES IN THE MEDICAL FIELD (cont.) PersonnelProviderCourseAttendeesRemarks RPORTC Training course for RPOs in radiotherapy
d1
The number of personnel to be trained does not justify development of a national course The regulatory body endorses the course
d provided at the RTC OperatorNTC
Radiation protection in the use of ionizing radiation in radiotherapy
8n.a.a QE
RTC
NTC (Phase 1) Training course in radiation protection in nuclear medicine, and TTT
course: how to be a lecturer
4e The TTT course is organized by
the NTC hiring as lecturers the attendees of the postgraduate educational course (which includes a module on
TTT)
NTC with: national university
,
Faculty of Physics, hospitals (Phase 2) Advanced course in radiation protection in nuclear medicine
16
The course makes use of the lecturers trained in Phase 1
TABLE 4. MATCHING THE TRAINING NEEDS WITH NATIONAL AND INTERNATIONAL RESOURCES AND CAPABILITIES IN THE MEDICAL FIELD (cont.)
Facilities and activities
PersonnelProviderCourseAttendeesRemarks
Nuclear medicine (cont.)
RPO
NTC with the RTC
Training course for RPOs in nuclear medicine
d3Basic moduled delivered at the NTC and practical module delivered at the R
TC The regulatory body endorsesd the
part of the course delivered at the RTC medicineNTC
Radiation protection in the use of unsealed sources in nuclear medicine
10n.a.a a n.a.: not applicable. b Postgraduate Educational Course in Radiation Protection and the Safety of Radiation Sources: Standard Syllabus [6] (a revised version of this publication is in preparation). c IAEA training material on radiation protection in radiotherapy [18]. d A syllabus for the training of RPOs at industrial and medical radiation facilities is in preparation. e Estimation of the number of trainers that must be trained (not the number of final trainees to be trained, as derived from Tables 1 and 2 in the other cases).
foreign organizations (e.g. the RTC) and on the soft (teaching) skills through a TTT course. The lecturers of the TTT course, organized by the NTC, will be selected from among those who attended the postgraduate educational course in radiation protection and the safety of radiation sources [6] (which includes a TTT module) to become QEs in radiation protection. Once the trainers have been trained, the NTC will establish an advanced training course for QEs in radiation protection in nuclear medicine in collaboration with the Faculty of Physics and hospitals, as already performed in the case of diagnostic and interventional radiology (Phase 2 in Table 4).
(ii) In the case of RPOs, the number of personnel to be trained might not justify the full development of a national training course. However, considering the objective of building national competence in this field, the country may consider adopting a training scheme with a basic module based on an IAEA syllabus for RPOs (which is under development), delivered by the NTC, and practical modules in nuclear medicine provided by a foreign organization (such as an RTC). For the basic module, the NTC could make use of the module included in the course for RPOs in diagnostic and interventional radiology which is delivered regularly in the country. This solution will enhance the use of national resources in a synergistic way. The regulatory body endorses the part of the course delivered at the RTC.
I.3.3. Outline of the national education and training programme (Section 4.4)
Matching the needs with the resources and capabilities provides the input for the national education and training programme that will identify which courses need to be organized in the next five years.
The maximum number of trainees that can be enrolled in each course will depend, inter alia, on the capacities of the organizations/institutions hosting the courses and the facilities required, particularly, for the practical exercises. The number of training courses that must be organized over the next five years in the medical field is presented in Table 5 (assessed on the basis of a maximum number of 20–25 participants per course).
In summary, the national courses needed, on average, in the next five years are:
(a) Two courses for QEs in the area of diagnostic and interventional radiology
TABLE 5. OUTLINE OF THE NATIONAL EDUCATION AND TRAINING PROGRAMME IN THE MEDICAL FIELD FOR THE NEXT FIVE YEARS
Facilities and activities Category of personnel
ProviderCourseNumber of courses Dental radiologyOperatorProfessional association
Radiation protection in the use of X ray generators in dental radiology
5
Diagnostic and interventional radiology
QE
NTC with: national university Faculty of Physics, hospitals Advanced course in radiation protection in diagnostic and interventional radiology
2 RPONTC
Training course in radiation protection in diagnostic and interventional radiology
2 OperatorNTC
Radiation protection in the use of ionizing radiation in diagnostic and interventional radiology
7 RadiotherapyQERTC
Postgraduate educational course in radiation protection and the safety of radiation sources
a
Based on schedule and availability
b
Specialized training course in radiation protection in radiotherapy
c
Based on schedule and availability
b
5. OUTLINE OF THE NATIONAL EDUCATION AND TRAINING PROGRAMME IN THE MEDICAL FOR THE NEXT FIVE YEARS (cont.)
Category of personnel
ProviderCourseNumber of courses QE (cont.)
National university: Faculty of Physics, hospitals Practice specific seminars and on the job training
As neededd RPORTC
Training course for RPOs in radiotherapy
e
Based on schedule and availability
b OperatorNTC
Radiation protection in the use of ionizing radiation in radiotherapy
1 QE
RTC
Training course in radiation protection in nuclear medicine
f
Based on schedule and availability
b NTCTTT course: how to be a lecturerf 1
NTC with: national university Faculty of Physics, hospitals Advanced course in radiation protection in nuclear medicine
1
Phase 2 Phase 1
TABLE 5. OUTLINE OF THE NATIONAL EDUCATION AND TRAINING PROGRAMME IN THE MEDICAL FIELD FOR THE NEXT FIVE YEARS (cont.)
Facilities and activities Category of personnel
ProviderCourseNumber of courses
Nuclear medicine (cont.)
RPO
NTC
Training course for RPOs in diagnostic and interventional radiology: basic module
e
1g RTC
Specialized course in radiation protection in nuclear medicine: practical module
e
Based on schedule and availability
b OperatorNTC
Radiation protection in the use of radioisotopes in nuclear medicine
1 a Postgraduate Educational Course in Radiation Protection and the Safe Use of Radiation Sources: Standard Syllabus [6] (a revised version of this publication is in preparation). b Depends on the time schedule of courses at the RTC and on the number of seats available to foreign participants. c IAEA training material on radiation protection in radiotherapy [18]. d Seminars and on the job training can be arranged by the Faculty of Physics of the national university, and by hospitals whenever the need arises. e A syllabus for the training of RPOs at industrial and medical radiation facilities is in preparation. f For building the competence necessary for establishing an advanced course in radiation protection in nuclear medicine for QEs (Phase 2 in Table 4). g Making use of one of the courses regularly provided by the NTC for training the RPOs in diagnostic and interventional radiology.
necessary for QEs in radiotherapy and nuclear medicine (Phase 1); in the latter area, in the long term, there will be an additional course for QEs using national resources (Phase 2).
(b) Two courses for RPOs in the area of diagnostic and interventional radiology using national resources. The course for RPOs in nuclear medicine is organized by the NTC and the RTC. The stakeholders should contact the RTC to plan the attendance of trainees at the practical modules delivered at the RTC after they have attended the basic module at the NTC. The training course for RPOs in radiotherapy is provided by the RTC; the stakeholders need to contact the RTC to plan the attendance of trainees.
(c) Fourteen courses for operators using national resources.
(d) A TTT course using national resources (Phase 1) in preparation for the national course for QEs in nuclear medicine (Phase 2).
I.4. DEVELOPMENT AND IMPLEMENTATION OF THE NATIONAL EDUCATION AND TRAINING PROGRAMME
I.4.1. Development of training courses to meet needs (Section 5.2)
Once the national education and training programme is designed, its development and implementation begins. It is important to ensure that the requirements for the training infrastructure are met, and to keep records on the courses and personnel being trained as well as to be aware of substantive changes in the projections (over the next five years).
The example provided below shows the development of training for RPOs in nuclear medicine (I.4.1.1.–I.4.1.3.). Some information about the target audience, the aims of the course, the delivery format, the syllabus, the providers of the training, and the examination is provided as well.
According to Table 5, the training scheme is based on a basic module provided by the NTC (making use of the module included in the training course for RPOs in diagnostic and interventional radiology already implemented in the country) and a practical module provided by the RTC. This will optimize the use of national human and material resources and allow, at the same time, for the development of core competence in a field where the national capabilities are still limited.
I.4.1.1. Background information on the training course for RPOs in nuclear medicine in the hypothetical country
The target audience is personnel to be designated as RPOs by the registrant, licensee or employer in accordance with the criteria established by the regulatory body to oversee the application of relevant requirements in nuclear medicine.
The aims and learning objectives are to provide theoretical and practical training in radiation protection and the safety of radiation sources to comply with the duties of RPOs in nuclear medicine.
The objective of the training is to have a full understanding of:
— Radiation protection principles and source safety necessary to effectively act as an RPO;
— General requirements of GSR Part 3 [2] when overseeing their application as an RPO;
— The role and duties of the RPO.
The syllabus is based on a core module and a practice specific module. The course will be delivered through classroom sessions, practical demonstrations, visits and on the job training.
I.4.1.2. Syllabus for the training course for RPOs in nuclear medicine in the hypothetical country: Core module
The core module will be organized by the NTC. On completion of the foundation training based on the core syllabus, the participant will:
— Have a basic understanding of radiation protection principles and source safety;
— Have a basic understanding of the requirements of GSR Part 3 [2];
— Understand the role and duties of the RPO.
As a prerequisite for the module, the participant needs to have secondary or tertiary education with a technical or scientific background.
Examinations will be held at the end of the core module (at the NTC). The topics covered by the core syllabus are listed below.
The RPO
— Introduction to GSR Part 3 [2]: brief overview of its objectives, scope and structure. This includes: